1. Existing WHO recommendations for Paediatric ART under review
WHO Paediatric Guideline Group meeting
Geneva, SWITZERLAND
Salle D
April 2008

2. Recommendation 1- when to start ART in infants
Intervention
Reco
QoE
Comment
CD4 < threshold for severe immunodeficiency, irrespective of clinical stage.
CD4< 1500
%CD4 <25
Strong
High
stage 4 irrespective of CD4
Moderate
stage 3 irrespective of CD4

3. Recommendations 2- testing in infants
Intervention
Reco
QoE
Comment
At or around 6 weeks of age is most efficient time at which to perform a viral test for an HIV exposed infant
Strong
Low
Programmatic expedience governed this recommendation- most infants are seen at this time and sensitivity and specificity for detection of infection acquired at or around delivery is >95%
Presumptive diagnosis of severe HIV may be made on clinical grounds with a history of HIV exposure and positive HIV antibody testing
Very low
Pragmatic and based on fact that early diagnosis not yet universally available

4. Recommendations 3 - what to start Infants
Intervention
Reco
QoE
Comment
2 NRTI + Nevirapine
(AZT + 3TC + NVP) preferred
(d4T+ 3TC + NVP)
Strong
Moderate
In severe anaemia -d4T for AZT
3 X NRTI
(AZT+ 3TC + ABC)
Conditional
Low
TB co therapy, hepatitis,
PI + 2NRTI
(AZT + 3TC + Lop/r)
Not recommended
Not stated
Preserve for 2LT